Method of identifying a lesion inside patient&#39;S tubular organ

ABSTRACT

A lesion identification system for surgical operations has a light marker adapted for placement in the vicinity of a lesion inside an organ of an organism, and a location-identifying device detecting a light emitted from the light marker at an outside of the organ for identifying a location of the lesion. The marker includes a light emitter and an engagement member associated with the emitter to be engageable with a wall of the organ. The engagement member includes a clip. The light emitter emits light with a wavelength in a near-infrared range. The device includes an endoscope comprising an inserter section having an image pickup element picking up a reflected light, involving the light from the light marker, at an outside of the organ, and an image pickup unit allowing the reflected light, picked by the image pickup element, to be generated as an image for display on a monitor.

CROSS REFERENCE TO RELATED APPLICATIONS

The present application relates to and incorporates by referenceJapanese Patent Application No. 2004-030509 filed on Feb. 6, 2004.

BACKGROUND OF THE INVENTION

1. Technical Field

The present invention relates to a lesion identification system forsurgical operation for identifying a marker indicative of a location ofa lesion of an organism.

2. Related Art

In modern surgical operations, various attempts have heretofore beenundertaken to provide techniques known in the art to assist operationsusing a marker, placed prior to executing the operations and indicativeof a location of a lesion in an internal site of a patient, as a fieldmark. As for these techniques, various techniques have been proposed inthe related art.

For instance, Japanese Patent Publication No. 2794162 discloses anoperation marker. The operation marker is comprised of a marker needlethat has one end to which a lead wire is fixedly fastened. With such astructure, as the marker needle is indwelt in a lesion inside thepatient prior to the execution of surgeries when executing, forinstance, a lung surgery with the use of thoracoscope and a leversurgery with the use of a laparoscope, the marker needle is left withthe lead wire exposed in the internal part. For this reason, the surgerycan be executed using the lead wire as a marker.

However, since there is a probability for the surgery marker to beinserted to the lesion by penetrating through a normal site on atranscutaneous fashion, lesion cells scatter, resulting in disseminationto occur.

Further, Japanese Patent Provisional Publication No. 3-78 discloses atube with a magnet for an organism. The tube, adapted for insertion tothe organism, has a distal end to which a magnet is fastened, andmagnetic fluxes resulting from the magnet are detected at an outside ofthe organism. Then, it becomes possible to detect a location of thedistal end of the tube indwelt in the organism for non-invading ability.

However, when executing endoscopic treatment to the organism, the tubewith the magnet for the organism is hard to take a proper response to anobservation image of an endoscope even if the location of the magnet isdetected.

When treating the lesion inside a digestive tract such as, for instance,a stomach, a rigidscope is probable to be used to execute an endoscopictreatment. One example of a technique for treating the lesion in such acase is described below. A soft endoscope is introduced to an inside ofa stomach through a mouth and, for instance, a light is dimmed. Whenthis takes place, using an illumination light from a light source of theendoscope allows a location of a lesion to be confirmed. Then, alaparoscope is inserted to a position suitable of the patient fortreating an identified lesion, upon which the lesion is treated.

However, in such a case, a need arises for a flexiblescope, unnecessaryfor surgical operation per se, to be prepared only for the confirmationof the location of the lesion (operation site) and, in addition, it isrequired to keep an operator who has an ability to manipulate theflexiblescope. Furthermore, after the operations have been completed,there is a need for rinsing, disinfecting and clearing off the endoscopeused for confirming the location of the operation site. For this reason,using the endoscope just for the positional confirmation to be executedduring surgical treatment is disadvantageous because of an increase inlabor hours, such as preparation and clearing off of the instrument,cumbersome and complicated techniques, keeping of the operator andincreased costs.

As proposals for further improving the technique of utilizing theillumination light of the endoscope, a luminous marking clip has beenknown from Japanese Utility Model Registration Publication No. 3027808.The marking clip incorporates a light emitter and is attached to aninner wall of an organ such as a digestive tract. This allows anoperator to look at a gleaming clip at an outside of the organ for theconfirmation of a location of a lesion. However, this clip is used forvisual observation and it is sometime hard to view the light emittedfrom the clip, providing a difficulty in usage. This light gleams to theextent as if the illumination of the endoscope is substituted to thelight emitter associated with the clip.

Another technique has been known. That is, when executing treatment on alesion inside, for instance, a large intestine on a laparoscopicfashion, a clip is preliminarily fixed to a surrounding of the lesionusing a flexiblescope. When treating the lesion using a rigidscope, forinstance, an X-ray is irradiated to the large intestine using an X-rayfluoroscope to obtain an X-ray transparent image. Thus, a location ofthe clip around the lesion is confirmed and, then, the lesion issurgically treated and extirpated.

However, in such a case, since the X-ray fluoroscope is used forconfirming the location of the lesion, issues arise for the patient tobe exposed to radioactivity. Also, the X-ray transparent image iscompletely different from the observation image obtained by thelaparoscope, resulting in a difficulty in identifying the location ofthe lesion in relationship between the X-ray transparent image and theobservation image from the laparoscope and confirming the relevantlocation concurrent with the treatment.

Furthermore, like the technology using the clip set forth above, incases where the treatment is executed on the lesion inside the largeintestine on a laparoscopic fashion, an ultrasonic device is used toapply an ultrasonic wave to a lesion for obtaining an ultrasonic imagein the vicinity of the lesion under the use of a laparoscope. That is,the lesion is treated upon confirming the location of the clip aroundthe lesion through the use of the ultrasonic image.

However, even in such a case, the ultrasonic image is completelydifferent from the observation image from the laparoscope and it is hardto identify the location of the lesion in relationship between theultrasonic image and the observation image of the endoscope.

In addition, like the two technologies using the clip set forth above,in cases where the treatment is executed on the lesion inside the largeintestine on a laparoscopic fashion, tattooing pigment is preliminarilyinjected to a surrounding of the lesion using the flexiblescope in placeof the clip described above. Then, since the pigment seeps to a serosaof a large intestine, the location of the lesion is confirmed using thelaparoscope for treatment on the identified lesion.

However, with such a technique, if a tattooing process needs to becontrived as described below depending on a site or if a certain amountof time has elapsed after the application of tattooing pigment,probabilities take place with the scattering of tattooing pigment andthe resultant difficulty in discriminating the lesion.

Additionally, another inconvenience takes place in the presence ofattempts made to confirm the location of the lesion based on thetechnique of using the ultrasonic image set forth above or the techniqueof injecting tattooing pigment. For example, there is a probabilitywherein a lesion is present in a region on a dorsal side opposite to aregion in which using a rigidscope allows an abdominal cavity to beobserved. Under such a situation, since the technique of using theultrasonic image undergoes a difficulty in transmitting an ultrasonicwave through the lesion in the presence of an air layer in an internalpart of a tube of the large intestine, it becomes hard to obtain theultrasonic image for identifying the lesion. Moreover, with thetechnique of injecting tattooing pigment, even when tattooing pigment isinjected to the surrounding of the lesion, no tattooing pigment seep toa wall portion of the large intestine at an site in opposition to thelesion, resulting in a difficulty of identifying the lesion using therigidscope.

SUMMARY OF THE INVENTION

The present invention has an object to identify a location of a lesionin an easy and reliable manner during surgical operations.

To this end, a lesion identification system for surgical operation ofthe present invention comprises a light marker adapted to be indwelt inthe vicinity of a lesion inside an organ of an organism to be targeted,and a location-identifying device detecting a light, emitted from thelight marker, at an outside of the organ to identify a location of thelesion.

With such a structure, the light marker is indwelt in the vicinity ofthe lesion, enabling the observation of the light (lights, such as avisible light and fluorescent light), emitted from the light marker,with the location-identifying device (for instance, an endoscope) via awall portion of the organ. This enables the lesion inside the organ tobe identified at the outside of the organ where the lesion is present.

Further, according to the present invention, a light marker for use insurgical operation is provided. In particular, the present inventionprovides the light marker adapted to be indwelt in the vicinity of alesion inside an organ of an organism to be targeted, upon which a lightemitted from the light marker is picked up at an outside of the organfor identifying the location of the lesion based on a location of thelight on the pickup image. The light marker is comprised of enengagement member that allows the light emitter to be engageable with awall of the organ, and an electric power supply supplying electricenergy to the light emitter to allow the light emitter to emit a lightafter the engagement member is attached to the wall of the organ.

Further, according to another aspect of the light marker of the presentinvention, a light marker is provided that includes a light emitterusing fluorescent substance that emits the light, and an engagementmember operative to allow the light emitter to engage the wall of theorgan. Furthermore, according to another aspect, the light markerincludes liquid, composed of viscous substance mixed with fluorescentsubstance, which is adapted to be injected to a site underneath a mucousmembrane of the lesion. In addition, according to a further aspect, thelight marker includes a plurality of beady fluorescent balls, in each ofwhich fluorescent substance is sealed, which is adapted to be introducedto the site underneath the mucous membrane of the lesion.

In the meanwhile, according to the present invention, a method ofidentifying a lesion for surgical operation is provided that includesindwelling a light marker in the vicinity of the lesion inside an organof an organism to be targeted, picking up a light, emitted from thelight marker, as an image at an outside of the organ, and identifying alocation of the lesion based on a position of the light on the pickupimage.

BRIEF DESCRIPTION OF THE DRAWINGS

In the accompanying drawings:

FIG. 1 is a typical view illustrating an overall schematic structurecommonly used for the lesion identification systems for surgicaloperation of various embodiments according to the present invention;

FIG. 2A is a schematic side view of the light source clip of a lesionidentification system for surgical operation of a first embodimentaccording to the present invention;

FIG. 2B is a schematic view showing a status in which the light sourceclip is viewed in a direction as shown by an arrow 1B in FIG. 2A;

FIG. 2C is a schematic block diagram illustrating an internal structureof a receiver case shown in FIG. 2A;

FIG. 3A is a schematic view of a rigidscope of the lesion identificationsystem for surgical operation of the first embodiment;

FIG. 3B is a schematic partly cut-away cross-sectional view of a camerahead of the rigidscope;

FIG. 3C is a schematic view of an adjustable filter section under astatus taken on line 2C-2C of FIG. 3B;

FIG. 4 is a graph showing a relative light intensity, of each of LEDswith wavelengths different from each other, in terms of a wavelength inthe lesion identification system for surgical operation of the firstembodiment;

FIG. 5 is a graph showing a light transmittance relative to an organism;

FIGS. 6A to 6C are graphs illustrating characteristics of opticalfilters located in the adjustable filter section of the lesionidentification system for surgical operation of the first embodiment;

FIG. 7A is a schematic cross sectional view of a flexiblescope to beused when the light source clip of the first embodiment is indwelt;

FIG. 7B is a schematic view illustrating a status in which an LED iscaused to emit a light with the light source clip engaging a mucousmembrane of an organ;

FIG. 8 is a monitor screen of a rigidscope in which an emitted light,resulting when the light source clip, indwelt in side a lung, is causedto emit the light, is displayed in a superimposed fashion with anobservation image obtained when an exterior of the lung is observed;

FIG. 9A is a schematic side view of the light source clip of the lesionidentification system for surgical operation of the first embodiment;

FIG. 9B is a schematic view showing a status in which the light sourceclip is observed in a direction as shown by an arrow 8B in FIG. 9A;

FIG. 9C is a cross-sectional view of a large intestine inside of which alesion is present;

FIG. 9D is a schematic view illustrating a status in which the lightsource clip is indwelt in the vicinity of a lesion shown in FIG. 9C soas to illuminate a abdominal cavity of a large intestine;

FIG. 10A is a schematic side view of a light source clip for use in alesion identification system for surgical operation of a secondembodiment according to the present invention;

FIG. 10B is a schematic view illustrating a status in which the lightsource clip shown in FIG. 10A is placed over a lesion and adhesive issprayed using an endoscope;

FIG. 10C is a schematic cross-sectional view showing a status in whichthe light source clip shown in FIG. 10B and the lesion are excised in anappropriate direction;

FIG. 11A is a schematic view illustrating a light source that isconfigured such that the light source clip of the second embodimentemits a light straight ahead;

FIG. 11B is a schematic view of a light source configured such that thelight source emits a light in a diffused fashion;

FIG. 12A is a schematic partially cut-away cross-sectional view showinga loop-shaped light marker for use in a lesion identification system forsurgical operation of a third embodiment according to the presentinvention;

FIG. 12B is a schematic perspective view of a light source of theloop-shaped light marker;

FIG. 13A is a schematic block diagram illustrating an internal structureof a receiver case of the light source of the loop-shaped light markerof the third embodiment;

FIG. 13B is a schematic view illustrating an internal structure of areceiver case;

FIG. 14A is a schematic view showing a distal end of an inserter sectionof an endoscope having two treatment implement insertion channels foruse in the lesion identification system for surgical operation of thethird embodiment;

FIG. 14B is a schematic view showing a status wherein a holder portionof the loop-shaped light marker is gripped in one treatment implementinsertion channel by a holder forceps while a clip device is located onthe other treatment implement insertion channel;

FIG. 14C is a schematic side view of an inserter section of an endoscopeshowing a status wherein the holder portion of the loop-shaped lightmarker is gripped in the treatment implement insertion channel by theholder forceps;

FIG. 15A is a schematic view illustrating a status wherein theloop-shaped light marker of the third embodiment is indwelt in anorganism using clips;

FIG. 15B is a monitor screen of a rigidscope showing a status wherein awall portion is pinched by the clips and observed at a side opposite tothe loop-shaped light marker using a rigidscope;

FIG. 16A is a schematic cross-sectional view of a fluorescent markercontaining fluorescent substance for use in a lesion identificationsystem for surgical operation of a fourth embodiment according to thepresent invention;

FIG. 16B is a graph illustrating a characteristic of a fluorescent lightin terms of an excitation light radiated to fluorescent light;

FIG. 17A is a graph illustrating a characteristic of a light source ofan endoscope for use in the lesion identification system for surgicaloperation of the fourth embodiment;

FIG. 17B is a graph showing a status in which characteristics of twofilters, disposed in an adjustable filter section of a rigidscope, aresuperimposed;

FIG. 18A is a schematic perspective view illustrating a status in whicha fluorescent light marker is entangled to an endoscope clip of thefourth embodiment;

FIG. 18B is a schematic view showing a status in which the clip iscaused to engage a mucous membrane of an organism together with thefluorescent marker;

FIG. 19A is a schematic side view of a fluorescent marker for use in alesion identification system for surgical operation of a fifthembodiment according to the present invention;

FIG. 19B is a schematic front view illustrating a status wherein thefluorescent marker is disposed in a distal end of an inserter section ofan endoscope with a ring elastically deformed so as to allow thefluorescent marker to be mounted to an endoscope hood;

FIG. 19C is a partially cut-away cross-sectional view taken along a line18C-18C of FIG. 19B;

FIG. 20A is a schematic view showing a status wherein an organism issuctioned to an inside of the hood using a suctioning function of theendoscope of the lesion identification system for surgical operation ofthe fifth embodiment;

FIG. 20B is a schematic view illustrating a status wherein the ring isreleased with the organism suctioned while the ring is elasticallydeformed to bind the organism under which the fluorescent marker isindewlt in the organism;

FIG. 20C is a schematic view illustrating a status in which a pluralityof fluorescent markers, containing fluorescent substances withwavelengths different from each other, shown in FIG. 19B are indweltaround a lesion;

FIG. 21 is a schematic view of a clip, having a base coated withfluorescent material, for use in a lesion identification system forsurgical operation of a sixth embodiment according to the presentinvention;

FIG. 22 is a schematic view of a clip having a base incorporatingfluorescent material for use in a lesion identification system forsurgical operation of a seventh embodiment according to the presentinvention;

FIG. 23 is a schematic view illustrating a status wherein fluorescentmaterial with a viscosity is injected to a mucous membrane of anorganism using a regional injection needle in a lesion identificationsystem for surgical operation of an eighth embodiment according to thepresent invention;

FIG. 24A is a schematic cross-sectional view illustrating an applicatorfor fluorescent balls, in each of which fluorescent material is filled,for use a lesion identification system for surgical operation of a ninthembodiment according to the present invention; and

FIG. 24B is a schematic view illustrating a status in which a mucousmembrane is partially incised and fluorescent balls are injected to aninside of the mucous membrane.

DETAILED DESCRIPTION OF THE PREFERRED EMBODIMENTS

Now, best modes (hereinafter referred to as various embodiments) forcarrying out the present invention are described with reference to theaccompanying drawings.

First Embodiment

First, a first embodiment is described with reference to FIGS. 1 to 9A,9B, 9C and 9D.

As shown in FIG. 1, a lesion identification system for surgicaloperation of the presently filed embodiment is comprised of light sourceclips 12 (see FIG. 2A) each serving as a light marker (marker) having alight emitting function and a clipping function, an endoscope (firstendoscope device) 66 (see FIG. 7A) serving as a soft scope for use inindwelling the light source clips 12, which will be described later, inthe vicinity of a lesion, and an endoscope (second endoscope device) 14(see FIG. 3A), serving as a rigidscope for surgical operation, whichdetect lights emitted by the light source clips 12.

In FIG. 1, further, reference P designates a patient (organ); OGdesignates an organ of the patient P to be targeted; and LP designates alesion of the organ OG. Also, trocars TR1 to TR3 are inserted to a siteof the patient P to be treated during operations. Among these trocarsTR1 to TR3, for instance, the trocar TR1 is connected to an abdominalgas supplier 13 and a scope (inserter section) of the endoscope device14 is inserted to an internal site while an instrument 16 is inserted tothe internal site using the remaining trocar TR3.

As shown in FIGS. 2A and 2B, the light source clip 12 includes a lightemitting light source 22, and a pair of engagement members (clipsegments) 24 with which the light source 12 is caused to engage andfixed onto an organism.

The light source section 12 is comprised of a power supply means, alight emitting means that emits a light in response to electric powerdelivered from the power supply means, and a receiver case 26, formed ina cylindrical shape with a bottom wall, in which both the electric powersupply means and the light emitting means are accommodated. As shown inFIG. 2C, the electric power supply means is comprised of a battery 28, aswitch circuit 30 and a sensor 32, all of which is accommodated in thereceiver case 26. The light emitting means includes an LED 34 that iselectrically connected to the switch circuit 30. The LED 34 is mountedto the receiver case 26 so as to protrude forward from the receiver case26. The sensor 32 is configured to detect radio waves, variation in amagnetic field or a light to deliver a resulting signal to the switchcircuit 30. The switch circuit is supplied with electric power from thebattery 28 in response to the signal from the sensor 32 to selectivelysupply electric power to the LED 34.

The engagement members 24 of the light source clip 12 serves as a fixingmeans by which the light emitting means, described later, is indwelt inand fixed to the internal site. The engagement members 24 are mounted tothe receiver case 26. Formed on an outer periphery of the receiver case26 is a pair of protrusions 38 formed with apertures, respectively. Pins40 are inserted to the apertures of the protrusions 38, respectively.The pins 40 carry springs 42, respectively. The springs 42 areintegrally formed with arms 44, each made of ultra-resilient alloymaterial, respectively. For this reason, the arms 44 are urged in givendirections, respectively. In this case, the arms 44 are oriented in thesame direction as the LED 34. The arms 44 have distal ends formed withclaw portions 46, respectively. The claw portions 46 are placed inface-to-face relationship. The engagement members 24, formed in suchconfigurations, are rotatable about axes of the pins 40 at angles of 180degrees, respectively.

The LEDs 34 of the light sources 22 have characteristics, depending onkinds, as exemplarily shown in FIG. 4 in an overlapped condition. InFIG. 4, the coordinate indicates relative light intensity and theabscissa indicates a wavelength λ (nm). In cases where a plurality oflight source clips 12 is employed, there is a probability for the LEDs34 of different kinds to be used with the characteristics shown in FIG.3. Here, description is made of first to third LEDs 34 a, 34 b, 34 cwhose characteristics are different from each other.

As shown in FIG. 4, the first LED 34 a emits a light with a peak valueat a wavelength of 800 nm. The second LED 34 b emits a light with a peakvalue at a wavelength of 1000 nm. The third LED 34 c emits a light witha peak value at a wavelength of 1200 nm. The first to third LEDs 34 a,34 b, 34 c, with such characteristics, are mounted to the respectivereceiver cases 26 on opening sides thereof, by which the first to thirdlight source clips 12 a, 12 b, 12 c are respectively formed.

As for the endoscope 14 set forth above, a hard one is used which isintroduced to an abdominal cavity from an outside of a body through, forinstance, the trocar TR2 or the like. Therefore, as used herein, the“endoscope 14” is referred to as a rigidscope (optical viewing tube). Asshown in FIG. 3A, the rigidscope 14 is comprised of an elongated hardinserter section 50, and a camera head 52 detachably mounted to a baseof the inserter section 50. Disposed in the inserter section 50 are anilluminating and optical system (not shown) and an objective opticalsystem (not shown) through which an illuminated site is observed. Theobjective optical system includes a relay lens through which an opticalimage, incident on the objective lens (not shown), is relayed to thebase of the inserter section 50. The illuminating and optical systemincludes a light guide (not shown) through which an illumination lightis guided from the camera head 52 to an illumination lens (not shown) ata distal end of the inserter section 50. Connected to the base of theinserter section 50 of the rigidscope 14 are a light guide cable 600through which a light is guided to the illuminating and optical system,and the camera head 52 equipped with a universal cable 53 that transmitsa pickup image from a CCD camera that will be described later.

As shown in FIG. 3B, the cameral head 52 includes a connector joint 54connected to the base of the inserter section 50, and an optical elementreceiver 56. The optical element receiver 56 is comprised of a CCDelement 58 that picks up an optical image relayed through the relaylens, and an adjustable filter section 60.

The CCD element 58 has a characteristic capable of picking up an opticalimage not only in a visible range (with a wavelength ranging from 380 nmto 780 nm) but also in a near-infrared range (with a wavelength rangingfrom 780 nm to 1300 nm). As shown in FIG. 3C, the adjustable filtersection 60 is rotatable about an axis of a pivot shaft 62 and has firstto third optical filters 60 a, 60 b, 60 c with characteristics differentfrom each other. With such arrangement, rotating the first to thirdoptical filters 60 a, 60 b, 60 c about the axis of the pivot shaft 62 ofthe adjustable filter section 60 for selection allows optical imageswith different wavelengths to be incident on the CCD element 58.

FIG. 6A shows a characteristic of the first optical filter 60 a. FIG. 6Bshows a characteristic of the second optical filter 60 b. FIG. 6C showsa characteristic of the third optical filter 60 c. In FIGS. 6A to 6C,the coordinates indicate light transmittances (%), respectively, and theabscissas indicate wavelengths λ (nm), respectively. Also, although allthe light transmittances in FIGS. 6A to 6C are plotted in the order of100%, it will be appreciated that, in actual practice, the lighttransmittance may be properly varied in use to values in the order of,for instance, 90% or 80%.

As shown in FIG. 6A, the first optical filter 60 a has thecharacteristic (region I) that transmits a light with a wavelengthranging from, for instance, 380 nm to 850 nm. This covers the light in anearly visible range. Additionally, this permits a light with awavelength, partly involved in the visible range in a near-infraredrange, to transmit through the first optical filter 60 a.

As shown in FIG. 6B, the second optical filter 60 b has a firstcharacteristic (region II) that transmits a light with a wavelengthranging from, for instance, 380 nm to 780 nm and a second characteristic(region III) that transmits a light with a wavelength ranging from, forinstance, 900 nm to 1100 nm. This covers the light in the nearly visiblerange. Additionally, this permits the light with the wavelength partlyinvolved in the visible range in the near-infrared range. Also, thelight transmittances in the regions II, III may differ from each otheror may be varied to suitable values depending on a detection status(caused by a wall thickness of a site to be treated or a lighttransmittance) of a light with a wavelength in an infrared range.

As shown in FIG. 6C, the third optical filter 60 c has the samecharacteristic (region II) as that of the region II of the secondoptical filter 60 b and has another characteristic (region IV) thattransmits a light with a wavelength ranging from, for instance, 1100 nmto 1300 nm. This covers the light in the nearly visible range.Additionally, this permits the transmission of a light with a wavelengthpartly (on a side closer to an infrared range with respect to thevisible range) involved in the near-infrared range. Also, the lighttransmittances in the regions II, IV may differ from each other or maybe varied to suitable values depending on a detection status of thelight with the wavelength in the infrared range.

Therefore, properly selecting the first to third optical filters 60 a,60 b, 60 c enables the CCD element 58 to pick up observation images inthe visible range and the near-infrared range, respectively. Althoughthe observation image (light) in the near-infrared range is not presentin the visible range and invisible in normal practice, connecting animage processor (recognition means) (not shown) to the CCD element 58provides a capability of executing image processing to allow the imageto be viewable (visible). The image processor has a function to make itpossible for a light with a wavelength in a near-infrared range to bevisible while having a function to modulate a contrast of the image andmake contour-emphasis. Then, an image (detected light) in thenear-infrared range is superimposed on an observation image in thevisible range for display over a monitor (not shown) to which the imageprocessor is connected.

As shown in FIG. 7A, the lesion identification system for surgicaloperation further includes the flexiblescope (first endoscope) 66 thatis adapted for insertion to an internal part of an organ through a nose,a mouth or an anus to allow the light source clips 12 to be indwelt to asite close proximity to the lesion or to treat the same. That is, theendoscope 66 is comprised of an elongated inserter section 68 and amanipulator section (not shown) mounted to a base of the insertersection 68. The inserter section 68 includes a flexible tube (notshown), which is flexible and connected to the manipulator section, anda flexing segment (not shown) disposed on a distal end of the flexibletube. The manipulator section is able to allow the flexing segment ofthe inserter section 68 to be operated in a flexing ability.

Disposed in the inserter section 68 of the endoscope 66 are anillumination optical system (not shown) for illuminating an object to betreated, an objective optical system (not shown) through which anilluminated site is observed, and a treatment implement insertionchannel (forceps channel) 70. The treatment implement insertion channel70 is available to insert a clip applicator 72 through which the lightsource clips 12 are guided to a site close proximity to, for instance, alesion.

The clip applicator 72 is comprised of a tabular member 74 in which theplural light source clips 12 are internally arrayed under a cascadedcondition, and a pusher 66 by which the light source clip 12, placed inthe rearmost side closer to the base of the tubular member 74, ispressed. As shown in a phantom line in FIG. 2A, the engagement members24 of the respective light source clips 12 are disposed such that theclaws 46 are oriented rearward against forces of the springs 42. Whenthis takes place, the light source clips 12 are set out such that theLED 34 is closer to a distal end of the tubular member 74. For thisreason, as the pusher 76 is moved forward in the tubular member 74, thelight source clips 12 are sequentially released from the distal end ofthe tubular member 74 to enable the engagement members 24 of each lightsource clip 12 to clamp a mucous membrane of the organism due to urgingforces of the springs 42. When this takes place, the light source clips12 are preferably filled inside the tubular member 74 to allow the firstto third light source clips 12 a, 12 b, 12 c, which have the first tothird LEDs 34 a, 34 b, 34 c with different characteristics,respectively, to be sequentially released.

Now, reference is made to FIGS. 7 to 9 to describe a basic sequence ofoperations for identifying the lesion 100 such as, for instance, a lung200 or a large intestine 300, with the rigidscope 14 through the use ofthe lesion identification system for surgical operation of the presentlyfiled embodiment. First, description is made of a case in which thelesion 100 is present in the lung 200 with reference to FIGS. 7 and 8.

The inserter section 68 of the endoscope 66 is inserted to an internalpart of the lung 200 through a bronchus until a distal end 68 a of theinserter section 68 is introduced to a site close proximity to thelesion 100. As shown in FIG. 7A, the clip applicator 72, whose treatmentimplement insertion channel 70 accommodates therein the plural lightsource clips 12 arranged in the cascaded manner, is inserted.Subsequently, the distal end of the tubular member 74 of the clipapplicator 72 is caused to protrude relative to the distal end 68 a ofthe inserter section 68 of the endoscope 66 until the distal end of thetubular member 74 is brought into a pressured contact with the site tobe clamped under which the pusher 76 is moved. Then, as shown in FIG.7B, the first light source clip 12 a is released to clamp the mucousmembrane at the site close proximity to the lesion 100 of a wall portioninside the lung 200.

When this takes place, the first light source clip 12 a, released fromthe clip applicator 72, permits the arms 44 to rotate at the angle of180 degrees about the axes of the respective pins 40 due to the urgingforces of the associated springs 42 for thereby causing the claws 46 toclamp the mucous membrane. Thereafter, the second and third light sourceclips 12 b, 12 c are similarly released from the distal end of thetubular member 74 to allow these clips to engage the mucous membrane ofthe lung 200 (see FIG. 7B) in a way to surround the lesion 100. That is,as shown in FIG. 8, the first to third light source clips 12 a, 12 b, 12c are fixed to the mucous membrane so as to surround the lesion 100.

Subsequently, an initiation signal, such as for instance a radio wave,which exceeds a given threshold value, is applied to the sensors 32 ofthe first to third light source clips 12 a, 12 b, 12 c, upon which theswitch circuits 30 are rendered operative to allow the battery 28 tosupply electric power to the first to third LEDs 34 a, 34 b, 34 c. Whenthis happens, the first to third LEDs 34 a, 34 b, 34 c of the first tothird light source clips 12 a, 12 b, 12 c, respectively, operate to emitlights. Under such a condition, after confirming operating conditions ofthe first to third light source clips 12 a, 12 b, 12 c with therigidscope 14, the inserter section 68 of the endoscope 66 is taken outof the internal part of the lung 200.

By the way, the coordinate in FIG. 5 represents a light transmittancewith respect to an organism and the abscissa represents a wavelength λ(nm). As shown in FIG. 5, a light of a wavelength in a near-infraredrange has a higher transmittance with respect to the organism than thatof a light of a wavelength in the visible range. Suppose that the firstoptical filter 60 a is selected by the adjustable filter section 60 ofthe camera head 52 of the rigidscope 14. A light (with a wavelength of800 nm) emitted from the first LED 34 a of the first light source clip12 a transmits through the wall portion of the lung 200 and is picked upby the CCD element 58 of the rigidscope 14 (see FIG. 6A). As shown inFIG. 8, the lights emitted from the first to third light source clips 12a, 12 b, 12 c are made visible (visualization) upon image processing anddisplayed together with an optical image from the rigidscope 14 in thevisible range over the monitor (recognition means) 80 via the imageprocessor. The optical image in the visible range forms an opposite realimage with respect to a side in which the light source clips 12 areindwelt at the wall portion of the lung 200.

Suppose that the second optical filter 60 b is selected with theadjustable filter section 60 of the rigidscope 14. A light (with awavelength of 1000 nm) emitted from the second LED 34 b of the secondlight source clip 12 b transmits through the wall portion of the lung200 and picked up by the CCD element 58 of the rigidscope 14. The pickupimage and the optical image, in the visible range, of the rigidscope 14are displayed over the monitor 80 shown in FIG. 8 (see FIG. 6B).

Suppose that the third optical filter 60 c is selected with theadjustable filter section 60 of the rigidscope 14. A light (with awavelength of 1200 nm) emitted from the third LED 34 c of the thirdlight source clip 12 c transmits through the wall portion of the lung200 and picked up by the CCD element 58 of the rigidscope 14. The pickupimage and the optical image, in the visible range, of the rigidscope 14,are displayed over the monitor 80 shown in FIG. 8 (see FIG. 6C).

That is, appropriately rotating the adjustable filter section 60 aboutthe axis of the pivot shaft 62 for selecting the first to third opticalfilters 60 a, 60 b, 60 c allows respective locations of the first tothird light source clips 12 a, 12 b, 12 c in the vicinity of the lesion100 to be observed using the rigidscope 14. For this reason, thepositional relationship among the first to third light source clips 12a, 12 b, 12 c can be identified. Since the lesion 100 remains inside thefirst to third light source clips 12 a, 12 b, 12 c, using the rigidscope14 enables the location of the lesion 100 to be identified at an outsideof the lung 200. Accordingly, the lesion 100 inside the lung 200 can berecognized (for identification) using the monitor 80 connected to therigidscope 14 and can be observed with the observation image of theoutside of the lung 200 in an overlapped condition.

Thereafter, under the observation through the rigidscope 14, the lesion100 and the light source clips 12 are surgically incised in a lump. Thatis, the lesion 100 is collectively incised with the light source clips12 attached to the lesion 100. When this takes place, since the lesion100 is collectively incised, it becomes possible to easily recognize aconfiguration under which the lesion 100 is present in the organism evenafter the lesion 100 has been incised. Under such a status, the first tothird LEDs 34 a, 34 b, 34 c, with the characteristics different fromeach other, of the first to third light source clips 12 a, 12 b, 12 care operated to emit lights which in turns transmit through the lesion100, permitting the lights to be picked up by the CCD element 58. Then,upon comparing the pickup image to the status wherein the lesion 100 waspresent in the organism, it is possible to easily specify a direction inwhich the lesion 100 was present in the organism. That is, confirmingthe extirpated lesion 100 in the presence of the light source clips 12enables not only the configuration when the lesion 100 was present inthe organism but also the direction in which the lesion 100 was presentin the organism to be easily recognized. Thus, it becomes possible toconfirm tissues upon excision and extirpation while understanding thesite (direction) to be additionally incised at once even when a leftoverlesion exists. Further, due to collective incision of the lesion 100together with the light source clips 12, no harm is caused to theorganism.

Also, though not shown, the adjustable filter section 60 may include anoptical filter with a characteristic that transmits a light withwavelengths in a visible range and a near-infrared range. By so doing,an observation image in the visible range can be obtained, while makingit possible to recognize the locations of the first to third lightsource clips 12 a, 12 b, 12 c at the same time.

Further, the light source clip 12 may take the form of a structure shownin FIGS. 9A and 9B. As shown in FIG. 9A, the engagement members 24 ofthe light source clip 12 are formed in a direction opposite to that inwhich the engagement members 24 of the light source 12 are located inFIG. 2A. Under such a situation, the engagement members 24 are urged ina direction opposite to the LED 34 of the receiver case 26.

With such a structure, a plurality of light source clips 12 are set outin the distal end portion of the tubular member 74 of the clipapplicator 72 such that the receiver case 26 is closer to the distal endof the tubular member 74 (not shown).

Next, description is made of operations when the lesion 100 is presentin the large intestine 300 shown in FIG. 8C. For instance, suppose thatthe lesion 100 is not present in a region α in front of a body (on anabdominal cavity side) but present in a region β on a dorsal side.

The light source clip 12 is clamped to and indwelt on a mucous membranein an internal part of the large intestine 300, as shown in FIG. 9D,using the clip applicator 72 disposed in the treatment implementinsertion channel 70 of the endoscope 66 that is inserted through ananus. When the LED 34 of the light source clip 12 is turned on to emit alight, the light is illuminated on a wall portion on the region a inopposition to the lesion 100. The light, with a wavelength transmittedthrough an illuminated wall portion, is picked up by the CCD element 58of the rigidscope 14. The light of the LED 34 is visualized on themonitor, thereby identifying the lesion 100. Therefore, not only incases where the lesion 100 is present on a side close proximity to thedistal end of the inserter section 50 of the rigidscope 14 in the largeintestine 300, but also in cases where the lesion 100 is remote from thedistal end of the inserter section 50 of the rigidscope 14, the lighttransmitting through the wall portion of the large intestine 300 ispicked up to allow the light to be displayed together with a real image,enabling a location of the lesion 100 to be easily visually recognizedat an outside of the large intestine 300. That is, the location of thelesion 100 can be easily identified using the rigidscope 14.

Also, while the presently filed embodiment has been described withreference to an exemplary implementation wherein the operations areexecuted using the plural light source clips 12 with the LEDs 34 ofdifferent kinds, an alternative may include a single light source clip12 in use and another alternative may include light source clips 12 withLEDs 34 of the same kind.

As set forth above, with the lesion identification system for surgicaloperation of the presently filed embodiment, there are advantageouseffects listed below.

Under a condition where the clip applicator 72 is inserted to thetreatment implement insertion channel 70 of the endoscope 14 throughwhich the distal end 68 a of the inserter section 68 is introduced tothe site close proximity to the lesion 100 of the organ, using the clipapplicator 72 enables the light source clips 12 to be easily indweltaround the lesion 100 of the organ.

Due to an ability of the LED 34 of the light source clip 12 wherein thelight, with the wavelength in the near-infrared range, which is easierto transmit through the wall portion of the organ than that with thewavelength in the visible range, is emitted in the internal part of theorgan, the transmitted light can be picked up using the CCD element 58of the rigidscope 14 at the outside of the organ.

For this reason, by image processing the light in the near-infraredrange with the image processor to allow the light, subjected to imageprocessing, to be displayed with the real image in the visible range ina superimposed manner, the location of the lesion 100 can be easilyrecognized at the outside of the organ on real time basis. That is, thelocation of the lesion 100 can be identified without difficulty. Also,the use of the endoscope provides an easier observation at part of thewavelengths of the near-infrared range, use of the wavelengths beingdesired for visual observation. This manner provides the ease ofidentifying the lesion.

Further, since the rigidscope 14 and the camera head 52, employed forsurgical operation through the use of the endoscope, are configured tooriginally have such an image pickup function, no other devices areneeded for identifying the lesion 100, making it possible to effectivelyutilize a space in an operation room. Thus, the lesion 100 can beidentified with a structure that is low in costs.

By so doing, it becomes possible to provide a lesion identificationsystem for surgical operation that is less expensive and simple inoperation, wherein merely confirming an observation image of therigidscope 14 enables the lesion 100 to be identified on real timebasis.

Second Embodiment

Next, a second embodiment is described with reference to FIGS. 10A-10Cand 11A-11B. This embodiment is a modified form of the first embodimentand the same component parts as those described in the first embodimentbear like reference numerals to omit detailed description. Hereunder,the way of such omission may similarly apply to third to ninthembodiments.

As shown in FIG. 10A, a light marker 12′ of a lesion identificationsystem for surgical operation of the presently filed embodiment differsfrom the light source clip 12, serving as the light marker, of the firstembodiment in shapes of the engagement members 24 and the receiver case26. The receiver case 26 has the same internal structure as that of thefirst embodiment described above.

An LED 34 of the light marker 12′ is formed in a hemispheric shape. Acenter of the LED 34 and a center of the receiver case 24 are aligned onthe same axis and a diameter of the LED 34 is formed in a larger sizethan that of the receiver case 24.

Further, the engagement members 24 are configured in a structure asmentioned below. Disposed in a step between the LED 34 and the receivercase 26 is a mesh-like member 112. The receiver case 26 has an outerperiphery formed with a threaded portion 114. The mesh-like member 112,disposed on an outer periphery of the receiver case 26, is screwed ontothe threaded portion 114 by a nut 118 formed with a discoid flangeportion 116.

Now, reference is made to FIG. 10 to describe operations of indwellingthe light marker 12′ with the mesh-like member 112 on the lesion 100using the lesion identification system for surgical operation of thepresently filed embodiment.

As shown in FIG. 10B, an organism-adapted adhesive spray catheter 120 isintroduced from a distal end of the treatment implement insertionchannel 70 of the endoscope 66 and organism-adapted adhesive 120 a issprayed onto the mesh-like member 112 of the light mark 12′ located inthe vicinity of a lesion 100 of a digestive tract wall 124. Then, thelight marker 12′ is adhered to a mucous membrane of an organism togetherwith the mesh-like membrane 112. In this case, adhesive 120 a may besprayed onto an outer circumferential periphery of the mesh-like member112 or an overall area of the mesh-like member 112.

Under such a situation, when the LED 34 of the light marker 12′ iscaused to emit a light, the presently filed embodiment provides the sameeffects as those described in connection with the case where the lesion100 is present in the large intestine 300 shown in FIG. 8C related tothe first embodiment.

Also, though not shown, under a situation where the LED 34 is broughtinto abutting contact with the digestive tract wall (lesion 100), it ispossible to obtain the same effects as those described above withreference to the situation where the lesion 100 is present under thepositional relationship between the light source clips 12 and theobserving means (rigidscope 14) shown in FIGS. 7B and 8 related to thefirst embodiment. Although the first embodiment has been described withreference to the implementation where the light source clips 12 areindwelt in the vicinity of the lesion 100, the second embodiment enablesthe light marker 12′ to be indwelt on an upper side of the lesion 100.Therefore, when observing the lesion 100 using the rigidscope 14, theposition of the light from the LED 34 of the light marker 12′ can beidentified as the lesion 100.

Further, while the second embodiment has been described in conjunctionwith the use of the mesh-like member 112, the mesh-like member 112 maybe replaced with a sheet-like member through which adhesive 120 apermeates.

Also, with the presently filed embodiment, while a direction (lightpath) of the light emitted from the LED 34 is oriented in a radialdirection of the hemispheric LED, the LED 34 may be configured to allowthe light path to extend straight. That is, an alternative may includethe LED 34 with linearity in a light path. Moreover, another alternativemay take the form of a structure wherein an outer surface of the LED 34is formed in a roughened state with an uneven surface to diffuse thelight. The rate of diffusion and linearity of light emitted from the LED34 may be appropriately set depending on the positional relationshipbetween the lesion 100 and the rigidscope 14 and accuracy of detecting alesion position.

Third Embodiment

Now, reference is made to FIGS. 12A-12B to 15A-15B to describe a thirdembodiment.

As shown in FIG. 12A, a loop-shaped light marker 130 is employed inplace of the light markers (light source clips 12) described withreference to the first embodiment. The loop-shaped light marker 130 iscomprised of a tubular holder 32, a light source 22 mounted inside theholder 132, and a light guide 134 through which a light emitted from thelight source 22 is guided to an outside of the holder 132.

The light guide 134 is comprised of a tubular light guide base 136 thatis retained by caulking a distal end of the holder 132, and a lightguide 138 having both ends disposed in an inner aperture of the base 136and mounted to the same to allow the light guide 138 to extend from thebase 136 in a loop shape to serve as a loop-shaped light source. Thatis, the base 136 has a distal end that is fixedly secured to the holder132 by means of a first caulked portion 140 a.

The light source 22 is fixed in position on a base side of the holder132 by means of a second caulked portion 140 b. In particular, an outerperiphery of the receiver case 26 of the light source 22 is fixedlysecured to the holder 132 by means of the second caulked portion 140 b.

Formed on the holder 132 at an intermediate position between the lightsource 22 and the light guide 134 is a third caulked portion 140 c.Therefore, the third caulked portion 140 c defines a distance betweenthe both ends of the light source 22 and the light guide 138. It is sodesigned such that a light emitted from the LED 34 is condensed at anend portion 138 a by means of such a restricted distance. As aconsequence, a strong light is efficiently guided to the light guide 138from the end portion 138 a of the light guide 138 at all times. In orderfor a portion of the introduced light to leak from the light guide 138,the light guide 138 has one end face of a fiber is stripped to be bared.

The light source 22 is comprised of an electric power supply means, alight emitting means emitting a light upon receipt of electric powersupply from the electric power supply means, and a receiver case 26,formed in a cylindrical shape formed with a bottom wall, whichaccommodates therein the electric power supply means and the lightemitting means. Formed on the receiver case 26 at a position (the bottomwall) remotest from the LED 34 of the receiver case 26 to be integralwith the receiver case 26 is, for instance, a flat plate-like retainer140 that is adapted to be gripped by a forceps 144 (see FIG. 14B).

As shown in FIG. 13A, the receiver case 26 has an internal structurethat generally includes a receiver means, a converter circuit 148, and alight-emitting element (LED) 34. As shown in FIG. 13B, the receptionmeans includes a receiver coil 150. The receiver coil 150 is appliedwith a varying magnetic field by means of a transmission means(transmission coil) 152. Then, alternating current occurs in thereceiver coil 150. The alternating current flows from the receiver coil150 to the converter circuit 148, by which the alternating current,resulting from the receiver coil 150, is converted to a direct current.Therefore, the LED 34 emits a light in response to the direct current.

As shown in FIGS. 14A and 14B, formed in the inserter section 68 of theendoscope 66 used in the presently filed embodiment are first and secondtreatment implement insertion channels (not shown). FIG. 14A shows alayout of the distal end 68 a of the inserter section 68. Formed on thedistal end 68 a are an objective lens 154, a pair of illumination lenses156 and first and second forceps outlets 158 a, 158 b formed incommunication with the first and second channels, respectively. As shownin FIG. 14B, the forceps 144 is disposed in the first channel incommunication with the first forceps outlet 158 a. Likewise, anendoscope clip device 160 is disposed in the second channel incommunication with the second forceps outlet 158 b.

(Modification of Third Embodiment)

Now, a modification of the third embodiment is described, in whichreference is made to FIGS. 15A and 15B to describe operations of placinga loop-shaped light marker 130 on a lesion 100 using a lesionidentification system for surgical system of the presently filedembodiment.

As shown in FIG. 14C, the loop-shaped light marker 130 is inserted to aninternal site under a situation where the retainer 146 of the lightsource 22 is preliminarily gripped with the forceps 144 at an outside ofthe internal site and indwelt in a position so as to surround aperiphery of the lesion 100 as shown in FIG. 15A. Of course, in caseswhere an outer diameter of the loop-shaped light marker 130 is smallerthan a diameter of the treatment implement insertion channel to beavailable for insertion, the loop-shaped light marker 130 may beinserted to the internal site through the forceps opening (not shown)while holding the loop-shaped light marker 130.

Upon keeping such a condition stated above, using the endoscope clipdevice 160, shown in FIG. 14B, allows the clips 160 a to pinch the lightguide 138 and the clips 160 a are caused to engage the mucous membraneas shown in FIG. 15A. With the light guide 138 clipped with the pluralclips 160 a while the respective clips 160 a are caused to engage themucous membrane, the loop-shaped light marker 130 is fixed in place in away to surround the lesion 100.

Under such a situation, the receiver coil 150 of the light source 22applied with, for instance, a varying magnetic field using thetransmitter coil 152, the LED 34 emits a light. The light emitted fromthe LED 34 is introduced from an end of the light guide 138 to theinternal part of the light guide 138. The presence of a leakage of lightintroduced to the light guide 138 allows the light guide 138 to emit alight.

For instance, since the large intestine is formed of a thin tissue, theCCD element 58 of the rigidscope 14 is able to pick up the light,emitted from the light guide 138, together with a real image of an outercoat of the large intestine 300. Then, as shown in FIG. 15B, aloop-shaped position of the light, emitted from the light guide 138, isdisplayed together with the real image of the outer coat of the largeintestine 300 over the monitor 80 via the image processor connected tothe rigidscope 14.

Also, upon using the LED 34 that emits the light with the near-infraredrange, it is possible to identify not only the lesion 100 present in thethin tissue such as the large intestine 300 but also the lesion 100present in a tissue thicker than the large intestine 300 in the sameway.

Fourth Embodiment

Now, reference is made to FIGS. 16A-16B to 18A-18B to describe a fourthembodiment.

As shown in FIG. 16A, the fourth embodiment contemplates to use afluorescent marker 212 as a light marker in place of the light markers(light source clips 12) described in conjunction with the firstembodiment. The fluorescent marker 212 is comprised of a transparentcapsule member 216 in which fluorescent substance (phosphor) is sealed,a cap 218 serving as a lid to close the capsule member 216, and a ring220 connected to the cap 218. Examples of fluorescent material include,for instance, riboflavin (vitamin B2), thiamine (vitamin B1), NADH(nicotinamide adenine dinucleotide), FMN (flavin mononucleotide), andICG (Indrocyanine Green).

FIG. 16B is a graph illustrating characteristics of an excitation light,needed for exciting ICG forming one of fluorescent material 214, and afluorescent light of ICG excited by the excitation light in anoverlapped relationship. In FIG. 16B, the coordinate indicates a lightintensity and the abscissa indicates a wavelength λ (nm). When theexcitation light (light with a wavelength in a visible range) with awavelength of approximately 765 nm is radiated to the ICG, thefluorescent light is emitted with a wavelength of about 830 nm.

FIG. 17A shows a characteristic of an illumination light introduced fromthe rigidscope 14. As shown in FIG. 17A, the illumination light of therigidscope 14 involves a light with a wavelength of 765 nm needed forexciting ICG. For this reason, the light source of the rigidscope 14used in general practice can be treated as an excitation light for theICG forming the fluorescent material 214.

FIG. 17B is a graph illustrating optical characteristics of the firstand second optical filters (not shown) of the adjustable filter section60 (see FIG. 3C) of the rigidscope 14 in an overlapped relationship. Thefirst optical filter has a characteristic that transmits a light with awavelength of, for instance, 380 to 730 nm. For this reason, the firstoptical filter is available to transmit a light with a wavelength in asubstantially visible range.

The second optical filter has a characteristic that transmits a lightwith a wavelength of, for instance, a value exceeding 780 nm. For thisreason, the second optical filter is available to transmit a light witha wavelength in a substantially near-infrared range. In this case, theadjustable filter section 60 is configured such that the second opticalfilter has a greater transmittance than that of the first opticalfilter.

Now, reference is made to FIG. 18 and description is made of operationsof indwelling a fluorescent marker 212, caught by the clip 160 a, in thelesion 100 using the lesion identification system for surgical operationof the presently filed embodiment. A region X in FIG. 18B designates asite inside a large intestine and a region Y indicates another site onan abdominal cavity. This similarly applies to FIGS. 23 and 24B.

As shown in FIG. 18A, the clip 160 a is inserted through the treatmentimplement insertion channel 70 using the clipping device 160 with thering 220 of the fluorescent marker 212 being caught by the clip 160 a ofthe endoscope, and the clip 160 a is caused to engage a mucous membraneof an organism to be indwelt in the vicinity of the lesion 100 as shownin FIG. 19B. This results in a condition where the fluorescent marker212 is indwelt in the organism.

Upon radiating an illumination light (see FIG. 17A), including anexcitation light from the light source (illuminating optical system) ofthe rigidscope 14, onto the fluorescent marker 212, fluorescent material214 is excited to emit a fluorescent light. For this reason, iffluorescent material 214, such as ICG, is excited due to the lightsource of the rigidscope 14, a fluorescent light with a wavelength of830 nm is released and selectively picked up by the CCD element 58 viathe adjustable filter section 60 of the rigidscope 14 at an outside ofthe large intestine 300.

Thus, the presently filed embodiment is able to have operations andeffects equivalent to those of the first embodiment set forth above.Particularly, the presently filed embodiment employs the fluorescentmarker having fluorescent material that emits a fluorescent light uponreceipt of an excitation light with a given wavelength. For this reason,by fixing the fluorescent marker onto a site close proximity to thelesion using the fixing means and using the endoscope to observe afluorescent light resulting from the excitation light radiated ontofluorescent material of the fluorescent marker, the lesion in the organcan be identified in a position outside the organ where the lesion ispresent.

Further, the excitation light of the above fluorescent material includesa light to be emitted from the light source of the above endoscope.Therefore, no need arises for preparing a new light source, enabling thelesion to be identified in a simplified structure.

Furthermore, the above fluorescent material may preferably includesubstance that emits a light with at least a portion of a wavelengthranging from 780 nm to 1300 nm in response to the above excitationlight. The fluorescent light with such a wavelength is easier totransmit through the organism than that of the wavelength less than sucha range. Thus, the use of the light with such a portion of thewavelength allows the lesion to be more easily observed with theendoscope, providing the ease of identifying the lesion.

Fifth Embodiment

Now, a fifth embodiment is described with reference to FIGS. 19A-19B to20A-20C. This embodiment is a modified form of the fourth embodiment andthe same component parts as those of the fourth embodiment bear likereference numerals to omit detailed description.

The ring 220 of the fluorescent marker 212 shown in FIG. 19A is formedof rubber material that is flexible (elastically deformable) in a radialdirection.

In the meanwhile, as shown in FIGS. 19B and 19C, a hood 24 is mountedonto the distal end 68 a of the inserter section 68 of the endoscope 66by which the fluorescent marker 212 is indwelt in the vicinity of thelesion 100. The hood 224 has a distal end a portion of which is formedwith a cutout 226.

Disposed on an outer periphery of the hood 24 for sliding capability isa tubular element 228. When the tubular element 228 is caused to pressthe ring 220, made of rubber material, to allow the same to drop offfrom the hood 224, the ring 220 is removed from the outer periphery ofthe hood 224 to contract in diameter.

Next, reference is made to FIG. 20 to describe operations of indwellingthe fluorescent marker 212 in the lesion 100 using the lesionidentification system for surgical operation of the presently filedembodiment.

As shown in FIG. 20A, a mucous membrane 302 of an organism is suctionedwith the distal end 68 a of the inserter section 68 of the endoscope 66.Then, the mucous membrane 302 is caused to deform toward the distal end68 a of the inserter section 68 and suctioned into an interior of thehood 224. Under such a status, as the tubular element 228 is movedforward to remove the ring 220 from the outer periphery of the hood 224,the rubber ring 220 contracts in diameter due to elastic deformation tobe brought into a condition where the rubber ring 220 binds the mucousmembrane 302 at a site in the vicinity of the lesion 100 as shown inFIG. 19B. Similarly, the fluorescent markers 212, containing fluorescentsubstances 214 with different characteristics, are fitted to the sitesaround the lesion 100. Therefore, as the fluorescent substances 214 ofthe fluorescent markers 212 are excited to cause the fluorescent markers212 to emit fluorescent lights with wavelengths of λ1, λ2, λ3, differentfrom each other, a location of the lesion 100 can be recognized(identified) through the rigidscope 14.

Sixth Embodiment

Now, a sixth embodiment is described with reference to FIG. 21.

As shown in FIG. 21, a mixture of fluorescent substance 214 and resinpowder is coated on an outer periphery of a base 160 b of the clip 160 aof the endoscope described in conjunction with the fourth embodiment.Thus, the clip 160 a has a function as a fluorescent marker. Examples ofresin may include polypropylene, polyethylene and polysulfon.Fluorescent substance may include the same constituents as those offluorescent substance described with reference to the fourth embodiment.As described in connection with the fourth embodiment, fluorescentsubstance 214 is excited with, for instance, the light source of therigidscope 14 to emit a fluorescent light with a given wavelength.

The clip 160 a operates in the same manner as that of the fourthembodiment. Due to fluorescent substance 214 coated on the clip 160 aper se, no need arises for advance preparation to entangle thefluorescent marker to the clip 160 a like the embodiment shown in FIG.18A, providing a remarkable ease in usage.

Seventh Embodiment

Next, a seventh embodiment is described with reference to FIG. 22. Thisembodiment is a modified form of the sixth embodiment and the samecomponent parts as those used in the sixth embodiment bear likereference numerals to omit detailed description.

As shown in FIG. 22, formed on the outer periphery of the base 160 b ofthe endoscope clip 150 a is, for instance, a plurality of recesses 160c. Filled in these recesses 160 c is fluorescent substance 214. The base160 b under such a state is covered with a transparent heat shrinkabletube 232. The heat shrinkable tube 232 is a tube that is caused toshrink upon application of heat at a given temperature. Therefore,fluorescent substance 214 is sealed in the recesses 160 c with the heatshrinkable tube 232.

The clip 160 a, serving as the fluorescent marker, operates in the samemanner as that of the sixth embodiment. Due to fluorescent substance 214disposed in the clip 160 a per se, there is no need for advancepreparation to entangle the fluorescent marker to the clip 160 a,providing a remarkable ease in usage.

Eighth Embodiment

Now, an eighth embodiment is described with reference to FIG. 23.

As shown in FIG. 23, fluorescent substance 214 is mixed withorganism-adapted substance, such as hyaluronate sodium that is viscoussubstance, into liquid, which in turn is injected to a site underneath amucous membrane 302 in the vicinity of the lesion 100 using a regionalinjection needle 240 under monitored conditions through the use of theflexiblescope 68. Under such a condition, fluorescent substance 214 isexcited using the light source of the rigidscope 14 and the resultingfluorescent light, emitted from fluorescent substance 214, is picked upby the CCD element 58 of the rigidscope 14. Other operational proceduresare similar to those of the fourth embodiment.

Ninth Embodiment

Now, a ninth embodiment is described with reference to FIGS. 24A and24B.

With the presently filed embodiment, in place of implementing theprocess to inject liquid, containing fluorescent substance 214 mixedwith hyaluronate sodium, into the mucous membrane 302 using the regionalinjection needle 240 described in connection with the eighth embodiment,the mucous membrane 302 of the organism is partially incised and beadyfluorescent balls 250, in each of which fluorescent substance 214 issealed, are introduced to a site underneath the mucous membrane using afluorescent ball applicator 252. Under such a condition, fluorescentlights are excited in the same manner as that described in connectionwith the eighth embodiment.

The fluorescent ball applicator 252, which is introduced to the mucousmembrane underneath of the organism, is comprised of a tubular member254 and a pusher 256. The tubular member 254 includes a flexible tube258 with a diameter available to be inserted to the treatment implementinsertion channel 70 of the endoscope 66, and a grip 260 located on abase of the flexible tube 258. The flexible tube 258 has a distal endwhose inner peripheral surface is formed with a corrugated shape inmatch with a size of each fluorescent ball 250. The pusher 256 iscomprised of a flexible wire 262 having flexibility, and a rotatablemember 264 connected to a base of the flexible wire 262.

The grip 260 has an inner peripheral wall formed with a female threadedportion 266. Formed on an outer periphery of the rotatable member 264 isa male threaded portion 268, which is screwed into the female threadedportion 266. Thus, as the rotatable member 264 is rotated, the rotatablemember 264 is moved forward or rearward to allow the fluorescent balls250 to drop off from a distal end of the flexible tube 258.

With such a structure, a part of, for instance, the mucous membrane 302of the organism is incised and the fluorescent balls 250 are introducedto the mucous membrane underneath. Then, the fluorescent balls 250 havethe same function as that described in connection with the eighthembodiment.

Also, the fluorescent balls 250 may be caused to adhere to the lesion100 using adhesive, resulting in the same operations and effects asthose obtained described above.

While the present invention has heretofore been described above inconnection with various embodiments with reference to the accompanyingdrawings, the present invention is not limited to such embodimentsdescribed above and involves all of implementations that can bepracticed without departing from the spirit and scope of the presentinvention.

1. A method of identifying a lesion which is present inside a tubularorgan of a patient for surgical operation, the method comprising thesteps of: delivering, using a first endoscope, a light marker to atubular organ of a patient to be targeted, the first endoscope being aflexible endoscope inserted through a natural opening of the patient,the light marker having an engagement member adapted to be engageablewith an inner wall of the tubular organ; having the light marker indweltin the vicinity of a legion of interest on the wall of the tubular organby allowing the engagement member to be engaged with the inner wall;picking up, using a second endoscope, the light emitted from the lightmarker, as an image, and transmitted through the wall at an outsideposition of the wall of the organ; identifying a location of the lesionbased on a position of the light on the image; and treating thepositionally identified lesion, wherein the treatment step includes aprocess of excising the lesion together with the light marker.
 2. Themethod of claim 1, wherein the light emitter comprises a passive typelight source that emits the light in response to excitation light, themethod comprising a step of permitting the second endoscope to radiatethe excitation light toward the light marker from outside the wall ofthe tubular organ to cause the passive type light source to emit thelight.
 3. The method of claim 2, wherein the passive type light sourceis fluorescent material involving fluorescent substance that generates,as the light, a fluorescent light with a wavelength involving at least apart of a wavelength ranging from 780 to 1300 nm in a near-infraredrange.
 4. The method of claim 3, wherein the excitation light includes alight to be emitted from a light source of the endoscope.
 5. A method ofexecuting surgical operation for a patient, the method comprising stepsof: inserting a first endoscope into a tubular organ of a body of thepatient via a natural opening of the patient, including a nose, mouthand anus of the patient, the first endoscope having an insertion tube inwhich a light marker is accommodated beforehand, the light marker havingan engagement member adapted to be engageable with an inner wall of thetubular organ; having the light marker indwelt in the vicinity of alesion of interest of the inner wall of the tubular organ by providingthe light maker from the insertion tube of the first endoscope such thatthe engagement member engages with the inner wall; inserting a secondendoscope into the body of the patient to enable a tip of the secondendoscope to reach a position located outside the tubular organ withinthe body of the patient, the position facing the lesion via the wall ofthe tubular organ; picking up, as an image, light emitted by the lightmarker from outside the tubular organ within the body of the object, byusing the second endoscope; identifying a position of the lesion in theimage; and treating the positionally identified lesion, wherein thetreatment step includes a process of excising the lesion together withthe light marker.
 6. The method of executing surgical operationaccording to claim 5, wherein the first endoscope is a flexibleendoscope.
 7. The method of executing surgical operation according toclaim 5, wherein the light marker indwelled in the light markerindwelling step consists of a plurality of light markers, the lightmarker indwelling step includes a step of providing the plurality oflight markers to the vicinity of the lesion such that the plurality oflight markers are indwelled in the vicinity of the lesion.
 8. The methodof executing surgical operation according to claim 7, wherein theplurality of light markers include light emitters that emit lights withmutually different wavelengths belonging to, at least, part of awavelength ranging from 780 to 1300 nm.
 9. A method of executingsurgical operation for a patient, the method comprising the steps of:inserting a first endoscope into a tubular organ of a body of thepatient via a nose, mouth or anus of the patient; having a passive typeof light marker fixedly indwelt in the vicinity of a lesion of intereston a wall inside the tubular organ of the body of the patient, by usingthe first endoscope, the passive type of light marker comprising afluorescent material; inserting a second endoscope into the body of thepatient to enable a tip of the second endoscope to reach a positionlocated outside the tubular organ within the body of the patient, theposition facing the lesion; radiating an excitation light from thesecond endoscope to the light marker from outside the wall of thetubular organ to cause the fluorescent material to emit light; pickingup an image of the tubular organ from outside the tubular organ usingthe second endoscope to acquire the image containing the light of thefluorescent material transmitted through the wall of the tubular organ;identifying a position of the lesion in the image; and treating thepositionally identified lesion, wherein the treatment step includes aprocess of excising the lesion together with the light marker.
 10. Themethod of executing surgical operation according to claim 9, wherein thefirst endoscope is a flexible endoscope.